Alzheimers Disease and The Impact of Music Therapy
Alzheimers Disease and The Impact of Music Therapy
Alzheimers Disease and The Impact of Music Therapy
Volume 5 | Issue 1
2017-2018
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ABSTRACT
Although a cure for Alzheimer’s disease (AD) has yet to be discovered, several non-pharmacological treatments
can improve patients’ quality of life and provide temporary relief from the disabling symptoms. One of these
treatments is music therapy. This systematic literature review evaluates the existing research on the relationship
between Alzheimer’s disease and music therapy, with a narrowed focus on familiar music therapy, the potential
mechanisms of action that explain the efficacy of this intervention, and the resulting nursing implications
that may be utilized in practice. A search of the Cumulative Index to Nursing and Allied Health Literature
(CINAHL) database returned 13 articles, which were analyzed and compared based on their level of evidence,
sample size, intervention, outcome measures, results, and limitations. The results of the literature review affirm
a clear relationship between music therapy and improved memory and cognition.
FAMILIAR MUSIC & THE PERSONAL PLAYLIST Arroyo-Anlló, Díaz, and Gil (2013) examined the effects of
Due to the “close links that exist between the elements that familiar music therapy on AD patients’ self-consciousness
make up music and the subject’s individual history,” the use (SC), and, although the described methodology did not
of meaningful, familiar songs with both active and receptive directly reference the term “personal playlist,” a comparable
interventions often acts as a key, unlocking forgotten approach was utilized during the study. The researchers
memories and allowing them to resurface to the patient’s focused on seven components of SC that deteriorate with
conscious mind temporarily (Guetin et al., 2013, p. 623). In the progression of AD: “personal identity, anosognosia
order to determine familiar music, music therapists conduct (lack of insight or self-awareness), affective state, body
a thorough patient assessment, following the previously listed representation, future memory, introspection, and moral
standards of clinical practice. By exploring the patient’s judgments” (Arroyo-Anlló et al., 2013, p. 1). As music therapy
cultural background, assessing aspects such as socioeconomic has the ability to enhance these aspects in AD patients, the
status, religion/spirituality, race, ethnicity, language, family researchers selected this intervention to explore whether
experiences, etc., music therapists are able to formulate an the use of familiar music would considerably improve parts
James Madison Undergraduate Research Journal 15
of the participants’ SC in comparison to unfamiliar music
(Arroyo-Anlló et al., 2013).
THERAPEUTIC INDICATIONS: SYMPTOM RELIEF
Due to the cognitive, affective, and behavioral stimulatory
responses elicited through both active and passive familiar
The study’s inclusion criteria mandated that all participants
music therapy, there are a diverse number of indications
be in the mild to moderate stages of AD; they were then
for the use of this therapeutic intervention with AD
evenly divided to eliminate any age, gender, or educational
patients (Guetin et al., 2013). Music therapy arouses
discrepancies, and randomly assigned to either the
autobiographical memories, evokes conversation through
experimental or control group. Both groups underwent the
speech facilitation, alleviates anxiety and depression, and
same pre- and post-intervention assessments, during which
diminishes the occurrence of agitated outbursts.
each participant completed two cognitive tests and a SC
questionnaire. The SC questionnaire, previously devised by
the same researchers for an earlier study, was comprised of
14 simple questions designed to assess the seven components
Music therapy arouses autobiographical
of SC. The intervention phase introduced a 36-week memories, evokes conversation
period of musical stimulation, which was broken down
into 2-4 minute sessions, three times a week. In a manner through speech facilitation, alleviates
equivalent to that of the personal playlist, each patient in
the experimental group listened to pre-selected popular anxiety and depression, and diminishes
Spanish music in their homes via headphones, while those the occurrence of agitated outbursts.
in the control group were assigned unfamiliar non-Spanish
songs (Arroyo-Anlló et al., 2013).
MEMORY LOSS
Researchers determined from the pre-intervention questionnaire Memory loss is one of the most distinguishing symptoms
results that there were no significant differences in any aspects of AD, gradually stealing away individuals’ personal
of SC between the experimental and control groups. However, identities, recognition of loved ones, and most cherished
following the musical interventions, a slight change was noted lifelong experiences. Fortunately, however, “emotionally
in the experimental group’s overall SC questionnaire score, charged memories are better encoded and remembered
while the control group’s score indicated further deterioration. than those with a low affective valence,” allowing patients
Therefore, researchers found a significant difference in the pre- to recall sentimental events more easily than unremarkable
and post-intervention scores between the two groups. All SC ones, reinforced through the stimulation of personally
aspects of the control group demonstrated further impairment significant music (Guetin et al., 2013, p. 629). The temporary
or were left unchanged following musical intervention with the recollection of such meaningful autobiographical memories
exception of body representation, which was shown to improve can help trigger patients’ remaining cognitive abilities,
(Arroyo-Anlló et al., 2013). Additionally, the experimental group potentially leading to a revival of verbal expression as they
revealed significant improvements in personal identity, affective attempt to communicate these past experiences (Guetin et
state, moral judgments, and body representation after familiar al., 2013).
music stimulation, while anosognosia, prospective memory, and
introspection remained unchanged (Arroyo-Anlló et al., 2013).
SPEECH AND COMMUNICATION DEFICITS
Arroyo-Anlló et al. (2013) concluded that the results Language deficits often develop as a result of deteriorating
confirmed their initial hypothesis, which surmised that neurological capabilities, which can lead to the inability
exposing AD patients to familiar musical selections would to generate spontaneous speech, naming difficulties,
lead to improvements in their SC. Although the control comprehension impediments, and discourse deficiencies.
AD group demonstrated progressive mental decline Discourse deficiencies are comprised of empty speech,
throughout the study, it remains undetermined whether ambiguous words, and useless repetitions. As the disease
this symptomatic deterioration was due to the unfamiliar progresses, AD patients attempt verbal communication less
musical exposure, the progression of AD, or other potential frequently, indicating the need for therapeutic interventions
explanations. Regardless, the findings of this study led that address these manifestations. Singing lyrics, interestingly
the researchers to conclude that “familiar music could be enough, seems to target the language centers in the brain,
considered as an enhancer not only of SC in AD, but also improving language capabilities through the promotion of
of the general cognitive state,” suggesting that familiar verbal fluency, articulation, and speech production (Dassa
music intervention could be an important therapeutic tool & Amir, 2014).
to improve quality of life for these unfortunate patients
(Arroyo-Anlló et al., 2013, p. 6).
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In one study exploring the impact of familiar music on or non-aggressively through both physical and verbal
conversational abilities in patients with middle- to late- mannerisms (Cox et al., 2011). The incidence of agitated
stage AD, the researcher encouraged the six participants behaviors tends to fluctuate intermittently throughout
to accompany her in singing carefully selected songs, the course of the disease, with the severity of symptoms
each followed by conversation facilitated through the remaining fairly consistent over time. Often occurring
use of open-ended questions. As intended, the topics of simultaneously with unmet personal needs, periods of
each question evoked related memories that spurred under- or over-stimulation, or interactions hindered by
conversation pertaining to relevant concepts, experiences, communication impediments, agitation is viewed as an
or emotions. The results of this study revealed several other expression “of despair, frustration, boredom, or loneliness”
enlightening findings, especially about the unexpectedly (Ledger & Baker, 2007, p. 331). Music therapy can lessen
enduring conversational abilities that remain well into the these agitated behaviors by heightening patients’ level of
later stages of AD. The researcher discovered, for example, arousal, redirecting their attention, creating a less fearful
that the act of singing elicited spontaneous remarks from environment, providing an outlet for self-expression, and
the participants. These included comments expressing not potentially reinstating meaning back into their lives (Ledger
only their individual enthusiasm and pride for successfully & Baker, 2007).
partaking in the interventions, but also the unity and sense
of belonging they experienced as a group—an important
revelation to note, for the inability of AD patients to Music therapy can lessen these
communicate with others can result in feelings of isolation agitated behaviors by heightening
and loneliness (Dassa & Amir, 2014).
patients’ level of arousal,
DEPRESSION AND ANXIETY redirecting their attention, [and]
Depression and anxiety become apparent as the patient
shows signs of disinterest and apathy towards social creating a less fearful environment.
interaction and/or previously enjoyed activities (Guetin et al.,
2009). As each manifestation of AD progressively worsens, One study conducted in a Specialized Care Unit explored
the patient’s sense of identity unravels, which according the impact of relaxing music on the overall agitation level
to theoretical literature is closely connected to escalating commonly present during dinnertime. Using the Cohen-
feelings of depression and anxiety. When researchers then Mansfield Agitation Inventory to measure the participants’
explored this proposed connection between identity, mood, agitation behavioral level, Hicks-Moore (2005) discovered
and quality of life, the resulting empirical evidence was there was a reduced incidence of agitated behaviors during
corroboratory (Caddell & Clare, 2012). Thus, interventions the two weeks that relaxing music accompanied dinnertime,
that preserve patients’ sense of identity can lessen the burden in comparison to music-free dinner times during the other
of depressive and anxious symptoms. observed two weeks. This musical intervention yielded not
only a reduced level of agitation, but also an increase in
In order to assess the efficacy of therapeutic musical socialization and communication among residents (Hicks-
intervention on both depression and anxiety, Guetin et al. Moore, 2005).
(2009) conducted a randomized, controlled study utilizing
receptive music therapy, in which the experimental group
participated in weekly music therapy sessions guided by THEORIES OF MECHANISMS OF ACTION
the “U” technique, while the control group took part in While ample evidence exists that demonstrates the beneficial
reading sessions conducted under the same conditions. The effects of music-based interventions for AD patients, there
music therapy group demonstrated significant symptomatic is a research gap regarding the potential mechanisms of
improvements in anxious and depressive behaviors, which action responsible for the witnessed effects of music therapy
were sustained for up to eight weeks following the cessation (Peck, Girard, Russo, & Fiocco, 2016). This specific body
of treatment, confirming music therapy as an effective of knowledge, once better explored and established, would
therapeutic tool for the short-term alleviation of anxiety and provide the means to legitimize music therapy as an evidence-
depression (Guetin et al., 2009). based treatment for AD, rather than a non-pharmacological
alternative intervention (Ahn & Ashida, 2012).
LIMITATIONS
Overall, the greatest limitations of this literature review
include 1) a lack of clinical research aimed at understanding
how music interacts with the underlying bodily systems,
and 2) a lack of research studying the long-term effects of
music therapy. A full list of limitations of the six articles
that address familiar music therapy included in the review
James Madison Undergraduate Research Journal 19
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